ABSTRACT
Introduction: The professional socialization is the process of which the individual gain values, norms, behaviors and social skills relevant to a profession and internalize a sense of identity to a specialized field. Therefore, the process begins at the first step of the nursing education program and continues with completion of nursing education till entering into the work place. Thus, the formation of nursing as a occupation takes place through professional socialization of individuals
Objective: This study is done with the aim of assessment of professional socialization level among nursing students at Guilan University of Medical Sciences
Methods: A cross sectional descriptive analytical approach was adopted. Participants were all nursing students at the faculty of Shahid Beheshti in Rasht. In total 211 students were chosen. Sampling was conducted with census. The instrument used was a Researcher made questionnaire that from the statements contained in the instruments by Shahim, and some of the items offered by Chao et al were given to samples. The data was analyzed with descriptive and inferential statistics [Independent T test, correlation Pearson coefficient, one way ANOVA, post Hoc Tukey]
Results: The finding of the study showed weak level [0%] and 40 students [19%] were in moderate level and most of the samples [81%] were in good level of professional socialization. In general, professional socialization had a statistically significant relationship with factors such as marital status [p=0.045], age [p=0.029,r=0.151], family residence [p=0.04], maternal education [p=0.023], student work [p=0.031], theoretical instructor [p=0.0001], clinical lecturer [p=0.032], having information about the nursing profession before entering the field [p=0.0001],compliance between previous image and existing realities [p=0.0001 ], interest in the course [p=0.0001]
Conclusion: From the research findings, the level of professional socialization of nursing students is acceptable. Recognition of the professional status can drew authorities' attention to provide opportunities for greater autonomy in practice and systematic holistic nursing care situations
ABSTRACT
Introduction: The pressure in the endotracheal tube cuff must be kept within an optimal range, to make sure tracheal capillaries circulation still stable during positive ventilation. This is essential to avoid oral and gastric stuffing aspiration
Objective: The objective of this study was to assess the endotracheal tube cuff pressure and time intervals measurements among intensive care units patients
Methods: This study was cross sectional designed to perform on 61 patients with oral intubation in the intensive care units, Rasht educational therapeutic centers, during the summer of 2013 for three months. A manometer was used to measure the cuff pressure twice every 6 hours interval. Different variables like age, sex, diagnosis, Body Mass Index and days intubated also were measured. All data obtained were analyzed using descriptive statistics [mean, standard deviation distribution] and inferential statistics [T test, Pearson, ANOVA]
Results: This study indicated that the cuff pressure was normal in 16.4% cases at the first step and after 6 hours, cuff pressure adjustment increased by 78.7%. The results show that correlation between days intubated and cuff pressure [in first evaluation P= 0.002, in second evaluation P=0.01] and BMI [in first evaluation P=0.007, in second evaluation P=0.03 were significant
Conclusion: This study showed that despite of 6 hours cuff pressure control, the range of miss regulation was 21.3%. This issue highlights that to prevent complication due to over and under inflation of cuff, a fewer intervals between cuff pressure control is required
ABSTRACT
Introduction: Acute Coronary syndrome is one of the most diagnosed and causes of death in the world, and treatment seeking behavior at the time of onset of symptoms and time spend on arriving to hospital is important for these patients, as it effects treatment and prognosis
Objective: The aim of this study was to determine treatment seeking behavior and related factors in patients with acute coronary syndrome referring to Heshmat Educational-Therapeutic center in Rasht city
Methods: This descriptive analytical study was conducted on 370 patients with acute coronary syndrome, who were admitted to emergency, CCU and cardiac units chosen by sequential sampling method. The instrument was a 3-part questionnaire consisting of demographic and social information, disease information and questions to determine treatment seeking behaviors. Data were analyzed using descriptive analytical statistics such as Chi-square, Man-Whitney and logistic regression
Results: The most common appropriate treatment seeking behaviors in the study population were rest [70%] and referring to heart related center [56.2%] and the most common inappropriate behaviors were not calling emergency medical services [85.9], not using sublingual TNG [68.6%] and delay for hours or days [60%]. There was a significant correlation between the most common inappropriate behaviors and sex, place of living, complete insurance, education level, job status, monthly income level, comorbidity chronic disease, kind of disease, severity of pain, length of morbidity, and hospitalization for angina pain, first impression of chest pain, method of referring to medical center and first referred center
Conclusion: In attention to inappropriate behaviors and transfer methods in majority of research samples in this study, educating high risk people is necessary
ABSTRACT
Introduction: Delirium is the most common neurological diagnosis among patients in intensive care units. The prevalence of delirium in the ICU patients is high and this is associated with many complications. Thus, by assessment and identifying predictive factors of delirium, its incidence can largely be prevented in intensive care units
Objective: This study aims to determine predictive factors of delirium incidence in patients hospitalized in intensive care units
Methods: This study is a descriptive-analytic study which included all patients admitted to intensive care units [neurology, general and trauma] in one of the training centers, Rasht for three months in 2013 without any symptoms and signs of delirium before hospitalization. There was no age limit for selection of samples. At least 24 hours after admission to ICU, with and without mechanical ventilation, ability to see and hear, Persian language, conscious or semi-conscious, not receiving neuromuscular blockers, coma, history of severe nerve damage [such as acute stroke, dementia, aphasia], chronic renal failure, alcohol abuse and drug abuse were the study inclusion criteria. Patients who used painkiller and sedatives during the study were excluded. Thus, samples were selected gradually considering the inclusion criteria. Based on the preliminary results with 20 samples, the study sample size was estimated 81. The tools used in this study were Richmond Agitation Sedation Scale [RASS] and Confusion Assessment Method for the Intensive Care Unit [CAM-ICU]. RASS is the standard tool to assess the level of restlessness and sedation in ICU patients. CAM-ICU examines four main characteristics of delirium; acute change or fluctuations in mental status, lack of concentration, disturbance of consciousness and unorganized thinking. The first part consisted of demographic characteristics including age, sex, Charleson comorbidity index, Acute Physiology Score [APS] in three ranges of 0-9, 10-14-and ?15, white blood cell count, serum total bilirubin, days of mechanical ventilation, and days of ICU stay and hospitalization. Charlson comorbidity index had 19 conditions in which the patient is scored based on its potential impact on mortality rate. APS is the biggest part of APATCH [Acute Physiology and Chronic Health Evaluation], obtained from 13 clinical evaluations performed 24 hours after ICU admission in which higher scores is indicative of worsening patient's physical condition. The second part consisted of examining the incidence of delirium in which patients were assessed by RASS in terms of level of consciousness. This tool consisted of 10 items, each representing one level of consciousness [of Combative to Unarousable]. To determine RASS, without any interaction, the patient was only observed and if conscious, she was scored 0 to +4. If the patient was unconscious, his/her name was called loudly and asked to look at the researcher. If the patient responded to call, appropriate score [1-3] was assigned. If there was no response, the patient's shoulder was shaken. If no response was observed, his/her sternum was strongly squeezed and appropriate score [4-5] was given. In case of no consciousness level disorder based on RASS, the subjects were assessed by CAM-ICU for examining delirium which took about 3-5 minutes. The collected data were analyzed using descriptive and analytical statistics [Fisher and chi-square]. For multivariate analysis of the associated factors with delirium, Backward Logistic Regression model was used. P<0.05 was considered the significance level. The probability of exclusion from the model was considered P< 0.1
Results: 64.2% of the subjects were male and most of them [48.1%] were hospitalized in the general ward. The majority of samples [49.4%] scored 0-9 in terms of APS. Charlson comorbidity index also showed most cases [29.6%] with 1-2 scores. The mean and SD of patients were 50.95 +/- 21.33 years, the maximum tracheal intubation days was 146 days. The maximum duration of ICU stay was 147 days and 150 days in the hospital. Furthermore, the maximum total bilirubin was 4.2 mg dl and the highest number of white blood cells was 29.2000 mg dl. Delirium was observed in 27.2% of samples using CAM-ICU. Delirium distribution was not significant based on qualitative variables; sex, ward and Charlson score whereas APS score which was significant [p=0.048]. Distribution of delirium was significant in terms of age [P=0.06]. However, it was not statistically significant in terms of the number of mechanical ventilation days, hospitalization and ICU stay, total bilirubin and white blood cell count. Based on logistic regression model, age, sex, days of tracheal intubation, ICU and hospitalization days, total bilirubin, white blood cell count, and Charlson index were not predictors of delirium. Only APS [considering the range of 0-9 scores as the reference] in two ranges of 10-14 [P<0.038] and ?15 [P<0.043] were identified as predictors of delirium. Thus, individuals with a score of APS=10-14 [OR = 3.3, 95% CI: 1.03-10.71] and APS ?15 [OR = 4.2, 95% CI: 1.08-16.7] had higher delirium compared to those with APS =0-9
Conclusion: Patients with APS points higher than those with lower scores are more likely to develop delirium
ABSTRACT
Introduction: nursing as a clinical discipline is developing daily in emergency wards and health care system managers should assess and prioritize clinical competence indicators in these wards continuously. Lack of clear clinical competence indicators challenges evaluation
Objective: this study aimed to determine general clinical competence indicators from nurses' viewpoint working in emergency wards
Methods: this is an assessment study using Delphi method in three phases: the first phase [determine the General Clinical competence indicators], Phase II [classifying general clinical competence indicators by members of the expert panel] third phase [prioritizing general clinical competence indicators using exploratory factor analysis] through which 710 nurses were chosen by convenience random sampling working in emergency wards affiliated to Guilan Therapeutic Educational Centers during a two month period. Finally, exploratory factor analysis was used
Results: in prioritizing phase of general clinical competence indicators, five factors statements were classified by the expert panel and provided a structured model in three domains which were divided as communication [10 items], disaster and emergency management [8 items] and personality characteristics [12 items]
Conclusion: a present alternative to reduce the gap between theory and practice in nursing is through determination and prioritization of clinical competence criteria in emergency wards. Factor analysis can be used to prioritize these indicators. Further research in health care system is ed in order to achieve reliable and valid instrument
ABSTRACT
Introduction: coronary artery bypass grafting surgery is a common therapeutic intervention in patients with coronary artery disease. This surgery has various complications. Electrolyte disorders are among common important complications among these patients
Objective: purpose of this study was to determine the level of electrolyte disorders and related factors in patients after coronary artery bypass grafting surgery hospitalized in cardiac care units
Methods: in this descriptive cross-sectional study, 288 Coronary Artery By Pass Graft [CABG] patients admitted to educational hospital were selected by gradual sampling. Data were collected by a three part researcher made questionnaire covering demographics, past medical history and levels of sodium and potassium through patients' medical records. Statistical analyses were performed using appropriate tests [chi square test, fisher exact test and logistic regression]
Results: findings showed that 16.7% of patients undergoing coronary artery bypass grafting were hyponatremia, 4.9% hypernatremia, 14.2% hypokalemia and 3.8% hyperkalemia. The results also indicated that there was a significant relationship between the factors such as body mass index, history of drug use, the number of vessels involved, the number of grafts, the length of time connected to mechanical ventilation, duration of artificial heart-lung machine use, aortic clamping time, and amount of intraoperative hypothermia, hemoglobin and hematocrit and postoperative electrolyte disorders [P<0.05]. According to Logistic regression model, these factors were not associated to electrolyte abnormalities
Conclusion: the findings showed that many factors such as individual medical history and condition during surgery can affect electrolyte abnormalities after coronary artery bypass graft. Identifying these factors can be useful in planning for prevention, diagnosis and early treatment of possible complications which in turn may result in promotion of quality care